Provider Demographics
NPI:1003263807
Name:NJ CERTIFIED DERMATOLOGY PC
Entity type:Organization
Organization Name:NJ CERTIFIED DERMATOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:L
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-521-6143
Mailing Address - Street 1:1580 LAKEWOOD RD
Mailing Address - Street 2:UNIT 16
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-3287
Mailing Address - Country:US
Mailing Address - Phone:732-456-7777
Mailing Address - Fax:
Practice Address - Street 1:26 HIGHWAY 35 N
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-4743
Practice Address - Country:US
Practice Address - Phone:732-456-7777
Practice Address - Fax:732-797-9110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-21
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ517245OtherMEDICARE PTAN
NJ0579912Medicaid
NJ1538594387OtherNPI
NJ1528209046OtherNPI
NJ1770873382OtherNPI
NJ1164604153OtherNPI
NYA400007917Medicare Oscar/Certification
NJ1922344399OtherNPI
NJA98014Medicare UPIN
NJP91958Medicare UPIN
NJ1538594387OtherNPI
NJG84056Medicare UPIN
NJ1164604153OtherNPI
NJI01072Medicare UPIN
NJ069341C2HMedicare PIN